Provider Demographics
NPI:1700835196
Name:KAZI, WASEEMUDDIN (MD)
Entity Type:Individual
Prefix:
First Name:WASEEMUDDIN
Middle Name:
Last Name:KAZI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9835
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92375-3035
Mailing Address - Country:US
Mailing Address - Phone:951-302-0888
Mailing Address - Fax:951-303-3666
Practice Address - Street 1:31537 RANCHO PUEBLO RD
Practice Address - Street 2:SUITE 204
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-4857
Practice Address - Country:US
Practice Address - Phone:951-302-0888
Practice Address - Fax:951-303-3666
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2016-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI39899-020207RC0000X
CAF3422010207R00000X, 207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32457200Medicaid
WI60018OtherDEAN HEALTH INSURANCE
683750484Medicare PIN
WI32457200Medicaid